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Journal of Cardiology & Current Research

Case Report Open Access Superior vena cava syndrome

Abstract Volume 11 Issue 6 - 2018 The superior vena cava (SVC) located in anterior , Carries from Juan Manuel Cortes Ramírez,1 Juan Manuel the head, , upper extremities and upper chest. Rodeada by rigid structures de Jesús Cortes de la Torre,2 Raúl Arturo and compress the upper originate vena cava syndrome (SVCS). The may be due to 3 obstruction external compression (benign or malignant), Fibrosis or thrombosis. Cortes de la Torre, Alfredo Salazar de 1 Venous hypertension produces head, neck and upper extremities azygos and deriving Santiago, Oscar Octavio Ramos Castelo flow systems. Symptoms depend on the speed of obstruction and location is quick .If Francisco Patiño Diego Lopez3 David symptoms are intense. More often slow installation. Initial symptoms, Drowsiness, Ricardo Ramirez Carranza1 tinnitus, dizziness, cervical increased diameter. If Endures, cyanosis of the face, neck, 1Area of Health Sciences, Autonomous University of Zacatecas, upper limbs, altered state of consciousness. Mexico 2Chair, Department of Cardiology, National Institute of Examination: Plethora jugular, thoracic collateral circulation. The diagnosis clinical, Cardiology, Mexico in tele-ray, mediastinal masses, pleural effusion, lobar collapse, or cardiomegaly. The 3Ignacio Morones School of Medicine, Mexico TAC defines the anatomy of mediastinal nodes and VCS, the site of obstruction and Provides guidance for needle biopsy, bronchoscopy or mediastinoscopy. Contrast Correspondence: Juan Manuel Cortes Ramírez, Area of venography, ultrasound and MRI are used to determine the site and nature of the Health Sciences, Autonomous University of Zacatecas, Mexico, obstruction. The treatment of malignant obstruction histological diagnosis by sputum Email requires cytology, biopsy or lymph. Received: October 25, 2018 | Published: November 15, 2018 Treatment: General Measures and the underlying cause, if or radiotherapy neoplastic in thrombosis, thrombectomy plasminogen activator (TPA), streptokinase or urokinase. Aangioplastia intraluminal stent, bypass in malignant etiology no chemotherapy and radiotherapy with improvement. Driving urgent: Patients with cerebral edema, airway obstruction due to compression of the trachea, for airway edema, or cardiac output decreased in venous return. Mortality depends on the underlying cause.

Keywords: superior vena cava syndrome, mediastinal masses, thrombosis

Introduction more intense. It is more frequent slow installation According the site of obstruction, you can be found as the above input Azygos, The superior vena cava (VCS) is located in the anterior the syndrome is less pronounced, Azygos distends quickly and mediastinum, he carries venous blood from head, neck, upper accommodates the blood and causes lower venous pressure head, arms extremities and upper chest to the right . Surrounded by more and chest.2 Blood returns to the VCS by internal and costoaxilares rigid structures: sternum, trachea and right main bronchus, , mammary , so that the venous circulation is not noticeable on pulmonary artery and enveloped by parahilar and paratracheal lymph the chest wall. It present distended jugular .5 Below the entrance 1 nodes, causing a distensible place and when compressed by any of the azygos vein−Symptoms and signs are more flowery, the blood 2,3 space-occupying lesion gives SVCS. Obstruction may be caused returns to the heart via the upper abdominal veins and inferior vena 4 by external compression, neoplasia, mediastinal lymphadenopathy, cava,2 large thoracoabdominal collateral circulation and lower limb fibrosis or thrombosis, leading venous hypertension of the head, edema and ascites.5 neck and upper extremities.2 The venous flow is then derived Azygos and its collateral systems (internal mammary veins, paraspinal The initial symptoms esophageal veins and venous network). Subcutaneous veins are the Headache increases with decubitus, drowsiness, tinnitus, dizziness, most important roads and engorgement in the neck and chest is typical increased cervical diameter.5 If thrombosis can present pain in the jaw, causes of SVCS. Malignant origin−bronchogenic Carcinoma−small neck and shoulder, without collateral circulation.2 If the compression cell, squamous, adenocarcinoma, and grandes. Hodgkin lasts cyanosis of skin, mucous face, neck, upper limbs, conjunctival cells and rarely Hodgkin. Breast carcinoma, thymoma and tumor hemorrhage, edema esclavina (face, neck and upper chest) cells metastatic tumors germinales. breast, testis colon. Benign predominance morning and exophthalmos time and macroglossia5 causes−Bocio endotorácico, Sarcoidosis, thrombosis associated will develop. In severe cases disturbances of consciousness4 with catheters pacemaker or-reservoirs or chemotherapy, as well as temporary and permanent catheters in hemodialysis patients 1. Other symptoms are hoarseness, nasal congestion, epistaxis, nefrópatas, Behcet,Mediastinitis fibrous (idiopathic or associated hemoptysis, dysphagia, pain, dizziness, syncope and lethargy.3 Histoplasmosis), Tuberculosis and syphilis (rare). 2 2. At physical examination: thoracic collateral circulation, varying Dependending symptoms of the rapidity of the establishment of plethora jugular. It may appear Horner Syndrome compression of obstruction and location.2 If it does quickly the symptoms will be the sympathetic chain in the mediastinum4

Submit Manuscript | http://medcraveonline.com J Cardiol Curr Res. 2018;11(6):225‒227. 225 © 2018 Ramírez et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and build upon your work non-commercially. Copyright: Superior vena cava syndrome ©2018 Ramírez et al. 226

3. ‘The diagnosis is clinical. without predominance of time, wheezy, hyperoxia, tired, exhausted, insomnia, lateropulsion, dorsalgia .disfonía ago , dyspnea small 4. Radiografía chest to look for mediastinal masses, pleural effusion, efforts, night sweats, back pain, facial edema, lower limb, abominal, lobar collapse, or cardiomegaly.5 and neck EFTA 90/60, FC 120X MIN, facial edema 90% shows an alteration. 75% is a mass in the right upper and neck, even sitting jugular plethora, thoracic venous network, mediastinum and 50% combined with a injury or hilar adenomegalia bilateral neck and underarm, edema and abdominal lymphadenopathy. 25% there is pleural effusion, usually on the right wall members inferiores (Figure 1). He underwent chest CT lung side.2 tumor reporting based region right evil-looking, mediastinal tumor with calcifications and data invasion of and conditioning 5. The computed tomography (CT), it is defined the anatomy of svcs superior vena cava, mediastinal lymphadenopathy of bilateral 6 mediastinal nodes affected. Of choice to evaluate the anatomy of hilar groups prevascular (Figure 2) (Figure 3). the mediastinum and the structure of the VCS. Locates the site of obstruction and serves as a guide for biopsy by mediastinoscopy, bronchoscopy or aspiration.4 6. La contrast venography, ultrasound and magnetic resonance imaging to determine the site and nature of the obstruction.6 The latter has no advantage over the TAC.3 7. In patients with known malignancy is not necessary to conduct further diagnostic techniques.3 8. The treatment of malignant obstruction depends on the histology of the tumor, should make a histological diagnosis6 by sputum cytology, biopsy of the tumor mass or lymph CT guided puncturing susceptible.4 9. When there is no history of malignancy should be ruled benign causes.3 Treatment General measures Figure 1 Clinical examination. Avoid lying, Rest in semi-sitting position, Oxygen, Diuretics, low- sodium diet, Corticosteroids1 Emergency management In patients with cerebral edema, obstruction of the airway by compression of the trachea or airway edema, decreased cardiac output or by decreased venous return.4 The underlying cause neoplasic, chemotherapy offers improvement over 65% of the SVCS are produced by highly chemosensitive and curable neoplasms.1 The treatment of choice of primary mediastinal B-cell lymphoma is chemotherapy, radiotherapy associating.2 The choice therapy is not sensitive tumors to chemotherapy.2 In patients with a thrombus in the VCS, thrombectomy with or without tissue plasminogen activator (TPA) or other thrombolytic, streptokinase or urokinase.6 Another treatment intraluminal angioplasty SX stents, bypass surgery in malignant etiology that have not improved with chemo- and radiotherapy.1 Complications The life-threatening complication when there is a mass in the upper mediastinum is the obstruction of the trachea and requires urgent treatment. Mortality does not depend on the obstruction but the underlying cause.3 Clinical case Male 55 years of age, genetic burden to you, dm, heart disease. Tab up to 6 months 5 cigarettes a day for 15 años. PA Starts 4 months myalgia and arthralgia, headache with decubitus, dizziness, dry cough Figure 2 Report of CT lung tumor.

Citation: Ramírez JMC, Torre JMJC, Torre RAC, et al. Superior vena cava syndrome. J Cardiol Curr Res. 2018;11(6):225‒227. DOI: 10.15406/jccr.2018.11.00404 Copyright: Superior vena cava syndrome ©2018 Ramírez et al. 227

Acknowledgements None. Conflict of interest Author declares that there is no conflicto of interest. References 1. Shims J, Lianes P, Cortés Funes H. Heart and neoplasias: Update. Heart diseases cardiac origin. Spanish Journal of Cardiology. 1998;51(4). 2. Zomeño Rodriguez M. Superior vena cava syndrome. Spain Med. 2000. 3. Gucalp R, Dutcher J. Oncologic emergency. In: Isselbacher KJ, Braunwaid E, Wilson JD, Martin JB, Fauci AS, Kasper DL, Harrison, editors. Principles of Internal Medicine. 15th edition. Mexico: Mc Graw- Hill publishers SA de CU, 2002;1:760−769. 4. Vargas CA, Martinez I. Superior vena cava syndrome. Guide for emergency management. Pan American Federation of Associations of Colleges and Schools of Medicine, 2004;19:1503−1506. 5. Arribalzaga EB. Mediastinal syndrome. In: Ferraina P, Oria, editors. Michans Surgery 5th Edition. Argentina: Editorial El Ateneo; 2003:372−373. 6. Quade G. Superior vena cava syndrome. Med News National Institute. 2002.

Figure 3 Report of CT lung tumor. Conclusion SVCS is a medical emergency, its importance lies in finding the underlying cause, often neoplasias. The installation depends on the location of the mass, speed of installation, therapy.Improper success of endovascular treatment is an effective and safe procedure, minimally invasive and low morbidity and mortality provide rapid improvement in the quality of life of patients compressive and symptoms.

Citation: Ramírez JMC, Torre JMJC, Torre RAC, et al. Superior vena cava syndrome. J Cardiol Curr Res. 2018;11(6):225‒227. DOI: 10.15406/jccr.2018.11.00404